Senior Configuration Analyst
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Job Description
Senior Configuration Analyst at Gravie creating and maintaining health plan configurations and adjudication logic for healthcare benefit solutions.
Responsibilities:
- Analyze benefit plan documents to accurately build benefit categories and adjudication rules to accurately and efficiently process claims
- Be a leader on the configuration team by supporting training, process development, and peer review / QA.
- Support cross-functional teams during implementations/renewals and develop solutions for plan variations.
- Provide support to team members for escalations and complex configuration requests.
- Perform root causes analysis of adjudication logic and benefit defects.
- Support special project implementations as required
- Create and update policies and procedures and other documentation of our accumulators and plan configurations.
- Perform quality reviews, regression and functional testing in support of configuration changes and application updates.
- Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented.
Requirements:
- 3+ years configuring accumulators and benefit plans or other related experience in payer business logic.
- 5+ years of experience as a claims examiner, coder, or other related experience working with medical claims data.
- Experience with adjudication processes, analyzing plan designs, and health plan information systems and applications.
- Knowledge/experience with self-funded, level-funded plan designs.
- Ability to set priorities, manage time, and work independently.
- Demonstrated success getting results through collaboration.
- Extra credit:
- Familiarity with the mPhasis, Eldorado, Javelina claims processing software.
- Working knowledge of EDI formats (837/835 claims, 270/271 eligibility) and coding systems (CPT/HCPCS, ICD, DRG).
- Experience in rapidly-growing start-up business environments.
- Understand file types A37, 270, 271, 276, 277, 278 experience.
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